The Vocational Rehabilitation Journey in Scotland: Reflections from an AHP Consultant by Jean McQueen
Essentially work is good for our health. Being out of work is detrimental to both an individual’s physical and mental health. In 2010 when I took up post not all health professionals believed this to be the case particularly for those with severe and enduring mental health needs. Few services asked their clients about their aspirations for work as part of routine practice and within Scotland there was only one service practicing an evidence based approach using the Individual Placement Support [IPS].
So armed with a passion for the topic and a background in research from my days as a research occupational therapist and practice development lead this post was a great opportunity and just the challenge I was looking for. My recent experience as a clinician in forensic mental health supporting patients with their aspirations for work really helped me appreciate the powerful impact the right work had on mental health and recovery. Providing an identity that was more than someone with a mental health condition. I remember clearly my patients talking about how they found it easier to manage their symptoms and stay well whilst involved in work related activities or the delight on one of my patient’s faces when she was invited to her work placements Christmas night out. It turned out no one had ever invited her to a night out before and to use her words she was ‘gleaming’.
In thinking about this blog I was also drawn to think about a discussion I had with an MSc Occupational Therapy student whose dissertation I was supervising. I can remember the puzzled look on her face when she told me about the compelling evidence she’d incorporated into her literature review on the IPS model. I had to agree with her it was puzzling that this evidence was out there and not being used in practice.
So with this AHP Consultant role I hoped to make a difference. I was no longer a clinician with responsibility for an assigned caseload, which of course is the most obvious way to make a difference. But I was sure with my skills the right support, the emphasis on welfare reform and political buy in there was the potential to offer those with mental health issues in Scotland something more than our ‘traditional’ models of practice. Here I could influence at a national level and still make a difference to patient care.
So reflecting back how would I describe my role. Well…..when you go to the theatre to see a play your attention is focused on the actors on the stage and their performance usually dictates how well you enjoy the whole production. But what about those behind the scenes the stage managers, costume designers and make-up artists, the lighting, scenery and the technicians whose performance is equally crucial in providing a satisfactory end result?
Well acting is not the only profession to need strong behind-the-scenes support. AHPs in Scotland working in forensic mental health have their own ‘backroom person’ whilst I have no ‘front of house’ clinical duties what I do is provide the foundation and props to develop truly effective evidence based vocational rehabilitation.
Evidence based practice is the conscious use of current best evidence in making decisions about the care of an individual patient. As a clinician the current pressures and demands dictate focus on clinical activity. Even with the best of intentions it is difficult for clinicians to find time to question practice, analyse the evidence and transform services and not all clinicians understand research papers and the statistics they contain.
So this is where I come in. My post commenced with the development of a national document ‘Towards Work in Forensic Mental Health’ and its messages were strengthened through the focus on work in the Scottish Mental Health Strategy and the AHP Delivery Plan but of course it takes more than that for true transformational change. Clinicians have to take ownership, feel involved, supported and inspired.
So as Jacqui Lunday-Johnstone our CHPO at Scottish Government would say ‘so what’, what difference has this made to practice? Well there is compelling evidence many more AHPs in forensic mental health are asking their patients about work. It’s hard to believe now, but we really weren’t doing it. In our national survey in 2010 only 13% of AHPs were asking their service users about work and by 2012 this had increased to 81%.
But of course it’s more than that as once AHPs ask the work question they need to feel confident to deal with the answer. My role involves working with clinicians across Scotland in variety of ways:
- supporting them to develop employability pathways
- emphasising the importance of partnerships with local employability services
- supporting clinicians to apply for grant funding for dedicated VR posts, arranging training and ongoing support on the IPS model, disclosure of mental health and criminal offences in the work place
- developing national consensus on standards of practice, outcome measures used
- supporting services to develop and transform, whilst representing AHPs at strategic level discussions on the mental health strategy or with the Department for Work and Pensions thereby linking up all the pieces of the jigsaw required to practice in a truly evidence based way.
Throughout Scotland eight health boards now offer an IPS service, but there is still some way to go even in these health boards. IPS is not available in every team. There is more work to be done not only in developing more IPS services but supporting those early implementors to evaluate and publish their outcomes.
I feel privileged to be on this VR journey providing the props to enable AHPs to perform well in vocational rehabilitation. I feel proud of what AHPs are achieving and lucky to be working with clinicians with a real ‘can do’ attitude. Thank you to all who are joining me on this journey, in particular Lisa Greer by fellow VR lead – we make a great double act. We still have some way to go, we’ve come far, but we now need to evaluate and measure our services though fidelity assessments, job outcomes, standardised assessments and publish our work in order to add to the evolving evidence on the impact AHPs and health has in this important agenda. Work really must be viewed as a health outcome.